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General NPI Number Information
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NPI Number | 1942296603
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Entity Type | Organization
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Legal Business Name | HOLLY STREET DRUGS INC
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Dates
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Enumeration Date | 09/27/2005
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Last Update Date | 06/18/2013
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Provider Practice Location Address
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Address Line | 712 HOLLY ST
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City | MC GEHEE
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State | AR
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Zip | 71654-2111
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Country | US
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Telephone | 870-222-3080
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Fax | 870-222-6561
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Provider Business Mailing Address
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Address Line | PO BOX 869
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City | MC GEHEE
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State | AR
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Zip | 71654-0869
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Country | US
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Telephone | 870-222-3080
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Fax | 870-222-6561
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Authorized Official
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Title or Position | OWNER
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Name | RONALD NORRIS
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Credential |
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Telephone | 870-222-3080
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | AR17673
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License Number State | AR
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